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Child Abuse and Neglect

Improving Abuse Evaluations in Community EDs

Clinical guideline recommending a phone consultation to Yale’s Child Abuse team and social work if an infant presents with at least one of 10 high-risk injuries associated with abuse.
Emergency care for children is provided predominantly in community emergency departments, where abusive injuries frequently go unrecognized. There are substantial differences between pediatric and community EDs in the access to subspecialty expertise, quality of pediatric care, and outcomes of pediatric patients. Following qualitative interviews with providers, quality improvement studies, and implementation of a clinical guideline, our targeted interventions have increased compliance with national guidelines for abuse evaluations and mitigated differences between pediatric and community EDs in the evaluation of high-risk injuries.

Clinical Guidelines and Decision Support

Our team has conducted various interventions to improve the care of infants presenting with abuse-associated injuries using a clinical guideline. Our child abuse guideline links ED providers with child abuse experts and has improved provider decision-making, decreased bias, and standardized care between pediatric and community EDs. We have developed natural language processing technology to identify high-risk injuries in the electronic medical record and are in the process of implementing electronic clinical decision support to sustain and augment the positive impact of the guideline across multiple EDs in the Yale-New Haven Health System.